An epidemic of varicella in rural southern India

In an epidemic of varicella investigated in rural southern India, an overall attack rate of 5.9% was observed. Attack rates were 15.9% among under-fives, 11.1% among school children (5-15 years) and 24% among those 16 years and more. None of the persons in the older age groups (16 years or more) suffered from severe forms of the illness or died. Among the 292 cases, three children (3,3 and 5 years of age) died (1% mortality). Their deaths were unusual since they occurred during convalescence from the illness, all three occurred at night during sleep, and all were girls. In the absence of a history suggestive of any known complication of varicella, hypoglycaemia following varicella as the cause of death is hypothesized. It is suggested that death following varicella among children may be more common in India than earlier believed while deaths or severe complications among adults may be rarer than in other countries.